Health care costs in the United States have continued to increase because of the aging of the population, increases in the number of newly insured due to passage of the Affordable Care Act, and a host of other factors driven by fee for service delivery models and waste, administrative inefficiency, mistakes, fraud, etc. In 2013, United States Health care spending reached $2.9 trillion annually, which was approximately 18% of the GDP. As the population ages and average lifespan continues to increase, chronic disease will become more prevalent which leads to increased utilization of the health care system.
While the United States per capita health care spending is among the highest in the world, there are large variations in the quality of care delivered to the population. This creates an unfortunate paradox of high costs compared to other developed countries, but again poorer outcomes on key indicators compared to other developed countries. At the end of the day, the United States consumer is not getting value for the money spent to stay well.
Against this backdrop, Congress passed legislation that emphasized quality and changed how health care is delivered and providers are paid and incentivized e.g., the Physician Quality Reporting System (PQRS) which rewards physicians, who report standardized quality metrics to the Centers for Medicare and Medicaid services (CMS) and penalizes hospitals that don't report these data; the Patient Protection and Affordable Act which implemented requirements driven by value-based payment for health care services, and required that physicians be paid using measures of cost and quality of care by 2017.
With these new laws in place, the Government understood it needed to drive the changes it sought to achieve by fostering the adoption of efficiency measures. Technology was an obvious way to push efficiency throughout the healthcare system. The Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized adoption of EMRs and other technology. This radically changed the health care market as adoption of Electronic Medical Record (“EMR”s) increased dramatically in response to the $36B incentives to purchase Health Information Technology. As a result, many EMR vendors were established and rushed their systems to market with poor user experience. The reaction of physicians to these developments was generally negative. According to a 2014 Medscape survey, 22% of providers are defecting or have never participated in the program, 75% of eligible providers had not yet attested for stage 1 in the year 2013-14. So, while the program was designed to motivate physicians and hospitals to use the technology they bought with the government's assistance, it actually resulted in poor uptake of technology by developers.
That said, EMRs still have been more widely adopted. In essence, these systems provide computerized interfaces between medical professionals and their staff and patient, and have the potential to significantly improve and streamline the business of medical care. The process of summarizing past paper charts and medical history and inputting these data into an EMR system has been challenging. However, when the data are entered, a medical provider can track the delivery of medical care, access a patient's medical records, track billing for services provided, and follow a patient's progress. Because of these benefits, government requirements, and incentives, medical documentation has transitioned from mostly paper records to mostly electronic records over the past decade. According to the Department of Health and Human Services 78% of office based physicians and 59% of Hospitals use a basic electronic medical record or electronic health record.
However, these systems have mostly not met their promise because they typically include complex interfaces that require users to navigate through multiple layers, folders and/or windows to access even basic patient information. As a result, an HIMSS survey showed that 40% of physicians would not recommend their EHR to a colleague, 63.9% said note writing took longer with electronic health records, and 32% were slower to read other clinician's notes. A recent study by Medical Economics indicated that 67% of physicians are displeased with their EHR systems.
An underlying driver of this dissatisfaction is that medical knowledge is doubling every five years, diagnostic tests and procedures are exploding, and documentation requirements for payments are increasing. Doctors are becoming burdened with documentation and administrative tasks rather than spending their time as medical providers. As a result, the EMR system has created a barrier between the doctor and patient, where physicians have to turn their back to the patient to input their findings, and have to navigate through multiple screens to do so rather than interact directly with the patient. The potential of medical errors, over ordering or under ordering of diagnostic tests, and other related mistakes generally occurs because information is missed or buried in the electronic medical record, and/or information does not get transferred from the paper chart. Important laboratory results or reports from other physicians can be lost or are difficult to access.
Another set of problems revolve around finance. Physicians are trained to treat disease and are typically not trained to manage their practices and be business people. As a result, physicians increasingly rely on technicians, assistants, and other staff, often not qualified or properly trained to input information. Improper documentation or billing can occur, which the physician is liable for. Many current EMR systems require significant administrative overhead, and are prone to user error that can result in a discrepancy between billing, claims and payment for professional services and patient procedures. Physicians rarely know if what they had previously authorized to bill was in fact billed correctly, and rarely do physicians know if what they were paid was correct.
To compound the physician's challenge, insurance companies and federal insurance programs such as Medicare and Medicaid hold doctors personally liable for what is billed, paid, and documented. Severe penalties and even criminal charges can occur when errors are made. The government collected $2.5 billion for “wrongful under and over billing and inadequate documentation.” (e.g., see https://www.justice.gov/opa/pr/departments-justice-and-health-and-human-services-announce-over-278-billion-returns-joint)
Overall, while EMRs were meant to reduce costs and improve quality of care, the opposite has occurred. Dr. Steven Stack, president of the American Medical Association addressed this issue when he said. “More than half of the physicians who billed Medicare in the United States are currently being penalized 1% of their 2015 payments as a result of the meaningful use program. Imagine, in a world where a 2-year-old can operate an iPhone, graduated physicians are brought to their knees by electronic health records. When you have more than a quarter million physicians being penalized by the Government by a single program, I think that most people will understand the math. It is not that 250,000 plus physicians are the problems, it is most likely the single program they are being punished by.”
The overarching problem is that data input and currently available user interfaces are not aligned with the way physicians practice medicine. As Gary Botstein in Decatur, Georgia quotes “It's very easy to record large amounts of data in click off boxes. So, the emphasis is really on data collection but what physicians ought to be doing is data synthesis. They ought to be taking the data, putting it together and coming up a differential diagnosis and then figuring out what the best diagnosis is and then the best treatment. Most systems today are not designed for clinical care. They are set to comply with the Federal Regulations with policy makers as opposed to actual physician care.” A solution is needed that helps the physician synthesize information and populate and document the chart when they see a patient on one screen, not on multiple tabs.
In current EMR systems numerous fields and data entry must be placed in many different screens describing physician's findings. It takes a tremendous amount of time for data entry. A wrong click of a mouse can insert the wrong information. A tool is desperately needed that will help a physician review a summary of the patient's history on one screen. Further, the tool should act like a switchboard and enable auto-population of data, where information is documented in a patient's chart when the patient is evaluated. Most EMR systems separate each patient visit by tabs representing each date of service. Critical historic information related to patient testing, diagnosis, surgical histories, and complications are often dispersed on multiple tabs without any visual markers to identify which tab houses the information that a clinician needs to review. These cumbersome formats in the EMR cause significant delay in evaluating a patient and can lead to medical mistakes as information is lost in the confusing formatting. An improved system would provide a snapshot of the critical medical data along with the billing and compliance of the patients' treatment which is unique to existing EMR formats. In combining these critical data into one comprehensive format, the improved system would increase efficiency and accuracy of the patient evaluation process. Accordingly, there is a significant need for a tool that allows a physician to identify medical problems through data visualization, where data is presented and displayed telegraphically, and which enables the rapid identification of billing and collections. Since doctors are typically time constrained, the tool should allow the doctor to access information while examining a patient in order to quickly identify potential billing and or reimbursement problems, as well as medical problems, so that issues can be resolved with the patient in real time. The tool would thus enable the physician to be involved with revenue cycle management, while simultaneously double-checking documentation and reducing medical errors.
Physicians need a tool that will enable them to collect and evaluate their own clinical outcomes. This is important because pay for performance models will be implemented and compensation will be based on clinical and cost savings outcomes, rather than for services and procedures. At the heart of all pay for performance models is data analysis. Tinsley suggests “that tracking clinical data is essential in comparing pay for performance models. Even if a small practice can participate in large scale value based model, it can surely implement measures that track and reward quality patient management. There is always more money behind knowing the clinical outcomes and data behind doctors' requests. A lot of doctors are saving payer's money and not getting a piece of the pie.” A tool is desperately needed that can provide the physician with a summary of results of their medical care. This will then enable them to improve care and to negotiate rates with insurance carriers, and will help them in establishing cost saving methods for delivering care and determining if the care they provide meets set standards.
A tool is needed to alert the physician of important messages, letters and laboratory results that are not readily accessible in current EMRs, so they do not miss important findings. Physicians rely on surrogates, like technicians or receptionists to document information on each visit such as a chief complaint. Important alerts that the staff wishes to send to a doctor for a particular day should be communicated on the same page so that everything can be seen. Further, in some cases such alerts should be deleted at the end of the day, because it does not need to be part of a permanent medical record.
The Government has collected substantial sums of money from doctors and hospitals annually for either under or over billing, or wrongful billing. Physicians need a tool that helps them meet all compliance regulations and make certain that charges are billed correctly.
Most EMR systems are highly proprietary and do not communicate well with each other. This lack of interoperability presents a barrier to the transparent communication of health information. A tool is needed that can grab and summarize data from multiple sources and EMR systems. The proposed tool will conform to new interoperability standards proposed and allow for complete patient history no matter what EMR system is used.
Thus, it is recognized in the disclosure herein that allowing physicians to rapidly detect potential problems, inconsistencies, medical changes, potential billing errors, review diagnostic tests and navigate through the entire patient chart history, while enabling centralized access to remote electronic medical records causes a new computing function (e.g., the transmission of a new communication with two-way exchange of up-to-date patient information based on a patient examination on the same day, or during the patient examination, or immediately following the examination) is a technical problem for network communication and other server based technologies.